"Overly Complicated Treatments" Are Not Overly Complicated When Sub-classified for Neurocognitive and Sensory Motor Function

 I keep hearing on social media about "overly complicated treatments". I also keep hearing most of the same people promoting "simple" interventions and "keeping it simple". 

I would like to make a few points.

• Most of the same neurocognitive skill sets that are required to truly benefit from pain neuroscience education and treatments to reduce fear are the same as those for motor skill learning (e.g. attention, working memory). Why aren't these called "overly complicated"?
  
• When you subgroup people for neurocognitive function, suddenly there are no overly complicated treatments. Sure there is a small challenge and this is useful for neuroplasticity. 
• Pain is not simple. A simple intervention will most often provide basic results. This means either small treatment effects, or it will not alter the trajectory of the presentation. Musculoskeletal pain can present with a wide variety of Motor, Sensory, Behavioral, Psychological, Soft Neurological, Neuro-Immune-Sympathetic-Endocrine dysfunction.
  

There are many reasons for reduced neurocognitive function e.g.

• neurodevelopmental disorders
• learning difficulties
• neuro-inflammation / low grade inflammation
• endocrine dysregulation
• autonomic dysregulation
  
• post concussion syndrome
• atypical birth history
• major surgery as an infant
  

Education level is not very useful. There are too many false positives and negatives. It is not uncommon to see patients with higher education who have problems learning. This can also happen in the physiotherapy profession.

A patient who presents with low back pain could also have a wide variety of other relevant presentations

• developmental coordination disorder (with habitual use of end range spinal movements and poor sensory motor function)
  
• asthma
• irritable bowel syndrome
• sensory hypersensitivity 
• high blood pressure
• chronic sinusitis
  

Will a simple strengthening intervention sort this person out? No, but neither will a motor control based intervention. 

Simple doesn't have to mean strengthening. Neurological based interventions such as primitive reflex inhibition or postural reflex facilitation are also simple. These can be combined with basic neuromuscular interventions.

References

https://www.researchgate.net/publication/262912623_Neurocognitive_and_sensorimotor_deficits_represent_an_important_sub-classification_for_musculoskeletal_disorders_-_Central_Nervous_System_Coordination

https://www.researchgate.net/publication/339363667_O27_The_development_initial_reliability_and_construct_validity_of_the_motor_control_abilities_questionnaire